data translation tool (dtt) specification specification guide... · 2021. 1. 4. · dtt...

DATA TRANSLATION TOOL (DTT)

SPECIFICATION GUIDE

STATE IMMUNIZATION INFORMATION SYSTEM

(SIIS) Scientific Technologies Corporation

DTT Specification Guide

Scientific Technologies Corporation

4400 E. Broadway Blvd, Ste 705 Tucson, AZ 85711

Original: v1.0.0/2.7.3 090503 Revisions: v1.0.2/2.7.4 111903; v1.0.3/2.8.0 012804; v1.0.4/2.8.2 072704; v1.0.5/2.10.0 060605; v1.0.6/3.1.P.060806; v1.0.6/3.2.061606; v1.0.7/3.3.3.012407; v.1.0.8/4.0.0.020707; v4.0.b.041307; v4.3.0-02/22/08; 4.4.1-07/25/08; 4.7.0 (06/05/09); 4.7.1 (07/22/09); 4.7.2 (09/02/09); 4.7.3.1 (10/09/09 (name/number only)); 4.8.0 (06/07/10); 4.9.1 (09/30/10); 4.10.0 (02/28/11)

Scientific Technologies Corporation (STC) provides this material "as is." The programmatic and technical staff used their best efforts to prepare and test this material.

©2011 by Scientific Technologies Corporation (STC). All rights reserved. Other trademarks, service marks, products, logos, or services, are trademarks of their respective holders.

Document Number: DTT-SG-4.10.0-2.28.11

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Table of Contents

TABLE OF CONTENTS

1 Introduction Data Translation Tool (DTT) ...............................................1-1 About this Guide ................................................................................................................. 1-2

2 File Format Elements ...............................................................................2-1 Format................................................................................................................................. 2-1 File Size .............................................................................................................................. 2-1 Fields .................................................................................................................................. 2-2

3 Creating a Data File ..................................................................................3-1 The Process........................................................................................................................ 3-1 Common Data File Errors ................................................................................................... 3-1 Items to be sent to STC ...................................................................................................... 3-2 Instructions.......................................................................................................................... 3-2 STC Contact Information .................................................................................................... 3-3 DTT Data File Profile Form Example.................................................................................. 3-4 DTT Data File Profile Form Information.............................................................................. 3-5

Additional Information................................................................................................. 3-5 4 Appendices ...............................................................................................4-1

Appendix A: CPT and CDC Vaccine Codes ...................................................................... 4-1 Appendix B: State County Codes .................................................................................... 4-19

Arizona...................................................................................................................... 4-19 Idaho......................................................................................................................... 4-20 Indiana ...................................................................................................................... 4-22 Louisiana .................................................................................................................. 4-25 Washington............................................................................................................... 4-27 West Virginia............................................................................................................. 4-28 Wyoming................................................................................................................... 4-30

Appendix C: Ethnicity Codes ........................................................................................... 4-31 Appendix D: Race Codes ................................................................................................ 4-31 Appendix E: Inactive Codes............................................................................................. 4-32 Appendix F: VFC Eligible Codes ..................................................................................... 4-32 Appendix G: Anatomical Site & Route Codes ................................................................. 4-33

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iv

Anatomical SITE Codes............................................................................................ 4-33 Anatomical ROUTE Codes....................................................................................... 4-33

Appendix H: Manufacturer Codes.................................................................................... 4-34 Appendix I: Adverse Reaction Codes............................................................................. 4-38 Appendix J: ICD-9 Codes ................................................................................................ 4-44 Appendix K: DTT Data File Profile Form ......................................................................... 4-46

Patient Records ........................................................................................................ 4-46 Vaccination Records................................................................................................. 4-60 Lot Import (Load Inventory) into Facilities ................................................................ 4-67 Physician Records .................................................................................................... 4-70 Facility Records ........................................................................................................ 4-73 Lead Records ........................................................................................................... 4-79

Introduction

1 INTRODUCTION DATA TRANSLATION TOOL (DTT)

Provider billing systems and patient management systems (PMS) typically store data that immunization registries require.

Organizations benefit by using the automated processes to move the data from the initial point of entry (the billing system or PMS) to the immunization registry since manually entering the same data more than once is not desired.

Immunization Registry

Provider Billing/Patient Management

Systems

PatientsVaccinations

FacilitiesPhysicians/Vaccinators

Lead

ImportExport

For the purpose of immunization registries, this data consists of the following record types (a.k.a., data elements):

• Patient (demographics)

• Vaccinations

• Physicians (and/or vaccinators)

• Facilities

• Lead

Patient demographics and Vaccinations data are the most commonly sent files and are usually sent in one file. Lead data must be sent in the same file as Patient (demographics).

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1-2

These record types can be combined in either a single file (which is recommended), or multiple files (up to five files—one each for Patients, Lead, Vaccinations, Facilities, and Physicians). If multiple files are used, the files can be loaded in any order, but you will not be able to view the vaccinations until the associated patients are loaded.

Exports can be created through provider billing or patient management systems that can periodically be imported into the state’s central immunization registry using the Data Translation Tool (DTT). This tool is used to simplify creation of export files because it has the flexibility to accept files with varied formats.

Note: If you have an existing Export file for your application, you may not need to create a new file. Contact your state administrator for clarification. Additionally, if you have an existing profile that sends multiple files, refer to Appendix K for the DTT Data File Profile Form containing a list of required data elements.

When importing data to the registry, it is imperative that the appropriate data elements are provided and in an acceptable format. The order of the elements or fields is not critical; however, once a profile has been defined on the central registry, the file format must remain consistent.

ABOUT THIS GUIDE

This guide was prepared to be used as the specification instructions for setting up a file with the correct data elements (fields) for the DTT. It is not a replacement for the IWeb Application User Guide; thus, if instructions are needed for the actual use of the DTT Export and/or Import tool, please refer to the IWeb Application User Guide.

File Format Elements

2-1

2 FILE FORMAT ELEMENTS

This section of the document discusses the various file formats, file size, and field information.

For additional information, refer to Appendix K for the DTT Data File Profile form.

FORMAT

The file format can either be:

• Character Delimited (ASCII Text) – Although, the pipe symbol ( | ) is recommended, other characters may be used including the TAB character. The use of commas and periods are not recommended since these characters can be embedded within the data.

• Fixed Length Delimited– If using the record type of FIXED LENGTH, you WILL need to “pad or fill” the fields with trailing spaces (blanks) so the field is the correct length; otherwise, padding the fields is NOT recommended for the other file formats (Character or TAB).

• Tab Delimited

FILE SIZE

The maximum size for import files will vary depending on the Internet connection speed and quality; however, it is preferred to send a data set of 1000 records or more.


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FIELDS

The data elements can be referred to as the file content. The file content will contain fields of data.

The following guidelines pertain to field content for character-delimited, tab-delimited, and fixed length record types.

• Required and optional fields are listed in Appendix K: DTT Data File Profile Form. Required fields can be in any order, but should be consistent.

• Fields containing the word “Code” are referred to as “Code-based” fields. “Code-based” fields can be mapped or translated to the SIIS codes. Examples of “Code-based” fields are: Vaccine Code, Manufacturer Code, County Code, Ethnicity Code, etc. Code-based fields can be located in the Appendices section.

• Fields should not be “padded or filled” with the words “Unknown” or “Unreadable.”

• If valid data is not available, leave the field blank or empty.

• Fields have a maximum length. If the data length is larger than the maximum, it will get truncated (cut off at the field’s length).

• The data length can be smaller than the maximum—do not insert spaces after the data to attempt to make the field its maximum length unless your file format is FIXED LENGTH.

Creating a Data File

3-1

3 CREATING A DATA FILE

The process for creating a data file is listed below along with examples.

The fields, length, data type, and whether they are required or not, are listed in the tables located in the Appendix K: DTT Data File Profile Form. Additionally, there are other codes that may be used such as ICD-9 codes and are located in the Appendices section.

THE PROCESS

The process of creating a data file is as follows:

1. Create the data file. Refer to the section below titled, “Instructions” for details.

2. Send the data file to STC’s contact person in order to test the validity of the data before it goes into a production environment.

3. The file is received by STC and the following tasks are done:

• Tested for validity. It will be edited if necessary, and then returned to you with a report indicating whether the data passed or failed.

• If the data failed, the report will indicate what needs to be corrected before the data file will be ready to be imported into the IWeb application (production environment).

COMMON DATA FILE ERRORS

Some common errors that occur are as follows:


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• Records contain duplicate patient IDs.

• Each record is followed by two carriage returns.

• Address is represented by one field value rather than three fields.

Street Address, City, Zip Code

VERSUS

Street Address|City|Zip Code

• First Names and Middle Initial are concatenated on some but not all records.

John J|Smith

VERSUS

John|J|Smith

• Facility or Physicians are not identified by ID in a patient record, resulting in duplicate Physicians or Facilities.

• When composing field values, commas and special characters are used.

ITEMS TO BE SENT TO STC

The items that should be sent to STC for testing are:

• Data File.

• (optional, but preferred) DTT Data File Profile Form (Appendix K).

INSTRUCTIONS

The instructions are as follows:

1. Submit, preferably a data set of greater than 1000 records.

• 50,000 records are committed to the database at one time which is about every 10 minutes


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(this varies based on machine speed and how many columns are in the DTT profile).

2. Model the data set file to represent one record per line. Refer to the section titled, “DTT Data File Profile Form Example.”

• When sending a patient record, you must provide an example mapping with every record to include: Medical Record Number, Patient First Name, Patient Last Name, Patient DOB, Patient 1st Address / Street Line 1, Patient 1st Address / City, Patient 1st Address / State, and Patient 1st Address / Zip Code

3. Use only one carriage return at the end of each record. 4. Use a | delimiter between each field value. 5. Provide us with a mapping of your data file(s) by

completing the “DTT Data File Profile” form located in the Appendix K. This form should include example records, mapped field names, and field position in the records.

6. Forward the data file and the “DTT Data File Profile” form to the DTT Support Specialist (listed in the “STC Contact Information” section below.

STC CONTACT INFORMATION

The following DTT Support Specialist is your point of contact for any questions regarding this process:

Support Specialist: Meredith McNeill

Phone Number: 602-241-1502, extension 1111

Email Address: [email protected]

Fax Number: 602-241-1856

mailto:[email protected]


3-4

DTT DATA FILE PROFILE FORM EXAMPLE

The examples shown below represent the “DTT Data File Profile” form that is used to submit your data file. Each “record type” will have two tables: 1) a table for you to fill in your “sample” records, and 2) another table for the detailed list of fields. The example shown below depicts a patient record. The tables on the “DTT Data File Profile” form also provide an example of a record being sent.

Data File Profile Form Example Record type

Example Record Type Alpha (This is an example of how to complete the profile for a patient record.)

Please provide two examples records below:

Medical Record Number|Patient First Name|Patient Last Name|Patient DOB|Address|City|State|Zip|

125454|kermit|frog|10/26/1997|1442 E Main|phoenix|az|85306|90700|12/05/2006|3452983|Mary|Jones|K|101 Thomas|Phoenix|AZ|85018|

Detailed Description of Patient Record

Field Length Req? Mapped Value Field

Position

Medical Record Number 16 R ID 1

Patient First Name 48 R Client First Name 2

Patient Last Name 48 R Client Last Name 3

Patient DOB 10 R Client Date of Birth 4

Patient 1st Address / Street Line 1 48 O Mailing Address 1 5

Patient 1st Address / Street Line 2 48 O Mailing Address 2

Patient 1st Address / City 48 O Mailing City 6

Patient 1st Address / State 2 O Mailing State 7

Patient 1st Address / Zip Code 5 O Mailing Zip Code 8


3-5

DTT DATA FILE PROFILE FORM INFORMATION

The “DTT Data File Profile” form can be located in Appendix K and is the last appendix section so that you can easily remove it from this guide and fill it out.

The “DTT Data File Profile” form includes the following:

• Field Names

• Field Lengths

• Whether the field is Required or Optional field

• Mapped Value

• Field Position

• Data Type

• Any additional Comments

This form is to be filled out and preferably submitted to STC with your data file, and is used for testing your data file. You may also want to keep a copy of this information for your own records.

This form is provided to assist in the creation of your file and offers the “typical” fields to include per “record type.”

ADDITIONAL INFORMATION

The following information is provided to assist you in creating your file.

Fields containing the word “Code” are referred to as “Code-based” fields. “Code-based” fields can be mapped or translated to the SIIS codes. Examples of “Code-based” fields and their Appendix sections are:


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• Vaccine Code (Appendix A) • State County Codes (Appendix B) • Ethnicity Codes (Appendix C) • Race Codes (Appendix D) • Inactive Codes (Appendix E) • VFC Eligibility Codes (Appendix F) • Anatomical Site Codes (Appendix G) • Manufacturer Codes (Appendix H) • Adverse Reaction Codes (Appendix I) • ICD-9 Codes (Appendix J) • DTT Data Profile Form (Appendix K)

Appendices

4-1

4 APPENDICES

APPENDIX A: CPT AND CDC VACCINE CODES

If the CPT Code is not available, use either the SIIS Code or the CDC code. These codes are mapped to each other and will be translated. This table is alphabetized by CPT Description.

CPT Code

CPT Description SIIS Code SIIS Description

CVX Code

Expiration Date

N/A Pertussis Pertussis 11 11

N/A PPD Positive Result PPD Positive Result

200

N/A PPD Negative Result PPD Negative Result

201

N/A Smallpox Smallpox 207 75

N/A DTaP, 5 pertussis antigens

DTaP, 5 pertussis antigens

210 106

N/A Influenza Inactivated, 48+ mos,presv free

Influ Inact 48+ mos pres free

609

N/A Influenza Inactivated, 48+ mos,w/Thimerosol

Influ Inact 48+ mos w/Thimerosol

610

86480 QuantiFERON-TB Gold test (QFT-G)

QuantiFERON-TB Gold test (QFT-G)

199

86580 PPD (tuberculosis skin test) Intradermal

PPD Test 30 98


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CPT Code


CVX Code

Expiration Date


PPD Test 30 97


PPD Test 30 96

86585 PPD (tuberculosis skin test) Tine Test

PPD Test 30 97


PPD Test 30 96


PPD Test 30 98

86648 Diphtheria antitoxin Diphtheria antitoxin

58 12

90281 Immune globulin (IG), human for intramuscular use

IG 14 14

90281 Immune globulin (IG), human for intramuscular use

IG 14 86

90283 Immune globulin (IGIV), human, for intravenous use

Immune globulin, (IGIV)

15 87

90287 Botulinum antitoxin, equine, any route

Botulinum Antitoxin

48 27

90288 Botulism immune globulin, human, for intravenous use

Botulism IG, human, intravenous

500

90291 Cytomegalovirus immune globulin (CMV-IGIV), human for intravenous use

CMVIG 49 29

90296 Diphtheria antitoxin, Diphtheria 58 12

Appendices

4-3

CPT Code


CVX Code

Expiration Date

equine, any route antitoxin

90371 Hepatitis B immune globulin (HBIG), human, for intravenous use

HBIG 29 30

90375 Rabies immune globulin (RIG), human, for intravenous use

RIG 52 34

90376 Rabies immune globulin, heat treated (RIG-HT), human, for intramuscular and-or subcutaneous use

RIG 52 34

90378 Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 50mg, each

RSV-IgIM (RSV-MAb)

208 93

90379 Respiratory syncytial virus immune globulin (RSV-IGIV), human, for intravenous use

RSV-IGIV 209 71

90384 Immune globulin (IGIV), human, for intravenous use

RhIG, full-dose, intramuscular

300

90385 Rho(D) immune globulin (RhIG), human, mini-dose, for intramuscular use

RhIG, mini-dose, intramuscular

301

90386 Rho(D) immune globulin (RhIG), human, for intravenous use

RhIG, intravenous

302

90389 Tetanus immune globulin (TIG), human, for intramuscular use

TIG 13 13

90393 Vaccinia immune globulin, human, for intramuscular

VIG Vaccinia IG 211 79


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CPT Code


CVX Code

Expiration Date

use

90396 Varicella-zoster immune globulin, human, for intramuscular use

VZIG 36 36

90399 Unlisted immune globulin Unknown vaccine or IG

213 999

90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

Novel H1N1,All Formulations

1003 128

90476 Adenovirus vaccine, type 4, live, for oral use

Adenovirus, type 4, live, oral

400 54

90477 Adenovirus vaccine, type 7, live, for oral use

Adenovirus, type 7, live, oral

401 55

90581 Anthrax vaccine, for subcutaneous use

Anthrax 37 24

90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use

BCG 19 19

90586 Bacillus Calmette-Guerin vaccne (BCG) for bladder cancer, live, for intravesical use

BCG 19 19

90592 Cholera Cholera 26 26 1/1/2001

90632 Hep A, Adult dosage for intramuscular use

Hep A 2 dose - Adult

105 52

90633 Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule,

Hep A 2 dose - Ped/Adol

34 83

Appendices

4-5

CPT Code


CVX Code

Expiration Date

for intramuscular use

90633 Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use


34 31

90634 Hepatitis A vaccine, pediatric/adolescent dosage, 3 dose schedule, for intramuscular use


103 84

90636 Hepatitis A and hepatitis B (HepA-HepB), adult dosage, for intramuscular use

Hep A/Hep B - Adult

104 104

90645 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

Hib--HbOC 47 47

90646 Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

Hib-PRP-D 46 46

90647 Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate, (3 dose schedule), for intramuscular use

Hib--PRP-OMP 23 49

90648 Hemophilus influenza b vaccine (Hib), PRP-T conjugate, (4 dose schedule), for intramuscular use

Hib--PRP-T 24 48

90649 human papilloma virus vaccine, quadrivalent

HPV, quadrivalent

925 62


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CPT Code


CVX Code

Expiration Date

90649 human papilloma virus vaccine, quadrivalent

HPV, quadrivalent

925 137

90650 Human Papilloma Virus (HPV) vaccine, types 16,18, bivalent, 3 dose schedule for intramuscular use

HPV, bivalent 2003 118

90655 Influenza virus vaccine, split virus, preservative free, children 6-35 mos., for intramuscular use

Influ split 6-35 mos pres free

605

90656 Influenza virus vaccine, split virus, preservative free, 36 mos and older.

Influ split 36+ mos pres free

606

90657 Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular use

Influenza split, 6-35 mos.

602

90658 Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular use

Influ split 36+ mos

603

90659 Influenza virus vaccine, whole virus, for intramuscular or jet injection use

Influenza Whole 16 16 9/2/2003

90660 Influenza virus vaccine, live, for intranasal use

Influenza Nasal Spray

62 111

90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

Influenza, High Dose

615 135

90663 Influenza Virus Vaccine, pandemic formulation,

Novel H1N1,All 1003 128

Appendices

4-7

CPT Code


CVX Code

Expiration Date

H1N1-09, all formulations Formulations

90664 Influenza virus vaccine, pandemic formulation live, for intranasal use

Novel H1N1,Nasal

1000 125

90665 Lyme disease vaccine, adult dosage, for intramuscular use

Lyme Disease 60 66

90666 Influenza virus vaccine, pandemic formulation, split-virus, preservative free, for intramuscular use

Novel H1N1,Presv Free, 48+ Mos

1005 126

90667 Influenza virus vaccine, pandemic formulation, adjuvanted, preservative free for intramuscular use

Novel H1N1,Injectable, 48+ Mos

1008 127

90668 Influenza virus vaccine, pandemic formulation, split-virus, for intramuscular use


1008 127

90669 Pneumococcal conjugate vaccine, polyvalent, for children under five years for intramuscular use

Pneumococcal(PCV)

102 100

90670 Pneumococcal conjugate vaccine, 13 valent

Pneumococcal, PCV-13

614 133

90675 Rabies Intramuscular Rabies 40 18

90676 Rabies Intradermal Rabies Intradermal

63 40

90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use

Rotavirus, pentavalent RV5

116 116

90681 Rotavirus, Monovalent Rotavirus, monovalent

119 119


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CPT Code


CVX Code

Expiration Date

RV1 2 dose series RV1

90690 Typhoid vaccine, live oral Typhoid, oral 25 25

90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use

Typhoid, ViCPs 41 101

90692 Typhoid vaccine, heat- and phenol- inactivated (H-P), for subcutaneous or intradermal use

Typhoid, parenteral

601 41

90692 Typhoid vaccine, heat- and phenol- inactivated (H-P), for subcutaneous or intradermal use

Typhoid, parenteral

601 53

90693 Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)

Typhoid, parenteral

601 53

90693 Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)

Typhoid, parenteral

601 41

90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use

DTaP/IPV 974 130

90698 Diphtheria,tetanus toxoids and acellular pertussis, haemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP-Hib-IPV), for IM

DTaP/Hib/IPV 920 120

Appendices

4-9

CPT Code


CVX Code

Expiration Date

use

90700 Diptheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), children younger than 7 years, intramuscular use

DTaP 20 20

90701 diphtheria and tetanus toxoids and pertussis vaccine (DTP)

DTP 1 1

90702 diphtheria and tetanus toxoids (DT) absorbed for use in individuals younger than seven years, for intramuscular use

DT (Pediatric) 28 28

90703 Tetanus toxoid adsorbed, intramuscular use

Tetanus Toxoid, adsorbed

35 35

90704 Mumps virus vaccine, live, subcutaneous use

Mumps 7 7

90705 Measles virus vaccine, live, subcutaneous use

Measles 5 5

90706 Rubella virus vaccine, live, subcutaneous use

Rubella 6 6

90707 Measles, mumps and rubella virus vaccine (MMR), live, subcutaneous use

MMR 3 3

90708 Measles and rubella virus vaccine, live, subcutaneous use

M/R 4 4

90709 rubella and mumps virus vaccine, live

Rubella/Mumps 38 38 1/1/2003


4-10

CPT Code


CVX Code

Expiration Date

90710 measles, mumps, rubella, varicella vaccine

MMR/Varicella 54 94

90711 diphtheria, tetanus toxoids, and pertussis (DTP) and injectable poliomyelitis vaccine

DTP/IPV 55 1/1/2000

90712 poliovirus vaccine, live, oral (any type(s))

OPV 2 2

90713 Poliovirus vaccine, inactivated, (IPV), for subcutaneous use or intramuscular use

IPV 10 10

90714 typhoid vaccine Typhoid, oral 25 25 1/1/2000

90714 Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, for use in individuals seven years or older, for intramuscular use

Td Adult, Preserv Free

67 113

90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in individuals 7 years or older, for intramuscular use

Tdap 921 115

90716 varicella (chicken pox) vaccine

Varicella 21 21

90717 yellow fever vaccine Yellow Fever 32 37

90718 Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals seven years or older, for intramuscular use

Td (Adult) 9 9

90719 diphtheria toxoid Diphtheria 12

Appendices

4-11

CPT Code


CVX Code

Expiration Date

Toxoid

90720 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP) and Hemophilus influenza B vaccine (DTP-HIB) for intramuscular use

DTP/Hib 22 22

90721 diphtheria, tetanus toxoids, and acellular pertussis vaccine (DtaP) and Hemophilus influenza B (HIB) vaccine

DTaP/Hib 53 50

90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DTaP-HepB-IPV), for intramuscular use

DTaP/Hep B/IPV

203 110

90724 influenza virus vaccine Influenza--unspecified

108 88 1/1/2000

90725 cholera vaccine Cholera 26 26

90726 rabies vaccine Rabies 40 18 1/1/2000

90727 Plague vaccine, intramuscular use

Plague 50 23

90728 BCG Vaccine BCG 19 19 1/1/2000

90730 hepatitis A vaccine Hep A 2 dose - Ped/Adol

34 83 1/1/2000

90730 hepatitis A vaccine Hep A 2 dose - Ped/Adol

34 31 1/1/2000

90731 hepatitis B vaccine Hep B - unspecified

45 45 1/1/2000


4-12

CPT Code


CVX Code

Expiration Date

90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for subcutaneous or intramuscular use

Pneumococcal(PPSV)

31 33

90733 meningococcal polysaccharide vaccine (any group(s)) MPSV4

Meningococcal (MPSV4)

33 32

90734 Meningococcal A,C,Y,W-135 diptheria conjugate (MCV4)

Mening. (MCV4P)

918 114

90735 Japanese encephalitis virus vaccine, for subcutaneous use

Japanese Encephalitis

39 39

90736 Zoster (shingles) vaccine, live, for subcutaneous injection

Zoster, live 607 121

90737 Hemophilus influenza B Hib--unspecified 17 17

90738 Japanese encephalitis virus vaccine, inactivated for intramuscular use

Japanese Encephalitis-IM

612 134

90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use

Hepatitis B--dialysis

42 44

90741 Immunization, passive; immune serum globulin, human (ISG)

IG 14 14 1/1/2000

90741 Immunization, passive; immune serum globulin, human (ISG)

IG 14 86 1/1/2000

Appendices

4-13

CPT Code


CVX Code

Expiration Date

90742 Immunization, passive; specific hyperimmune serum globulin (eg, hepatitis B, measles, pertussis, rabies, Rho(D), tetanus, vaccinia, varicella-zoster)

IG 14 86 1/1/2000

90742 Immunization, passive; specific hyperimmune serum globulin (eg, hepatitis B, measles, pertussis, rabies, Rho(D), tetanus, vaccinia, varicella-zoster)

IG 14 14 1/1/2000

90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use

Hep B 2 dose - Adol/Adult

202

90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use

Hepatitis B--adol. or pediatric

8 8

90745 Immunization, active, hepatitis B vaccine; 11-19 years

Hepatitis B--adolescent, high risk

56 42 1/1/2001

90746 Hepatitis B vaccine, adult dosage, for intramuscular use

Hepatitis B--adult

43 43

90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use

Hepatitis B--dialysis

42 44

90748 Hepatitis B vaccine and Hemophilus influenza b vaccine (Hepb-Hib), for

Hep B/Hib 57 51


4-14

CPT Code


CVX Code

Expiration Date

intramuscular use

90749 Unlisted vaccine toxoid Unknown vaccine or IG

213 999

Hep B Ped/Adol - Preserv Free

100

Prev. Smallpox-Adulthood

223

Tick-Borne Encephalitis

2020 77

Rheumatic Fever

2016 72

Rift Valley Fever

2017 73

Parainfluenza-3 2014 69

Hep C 2005 58

Prev. Smallpox-Documented Date

221

VEE, NOS 2023 92

DTaP--unspecified

600 107

Pneumococcal - unspecified

205 109

Smallpox vaccine, diluted

212 105

Rabies NOS 916 90

Appendices

4-15

CPT Code


CVX Code

Expiration Date

TST-OT Tine Test

2019 95

Typhus, Historical

613 131

Novel H1N1,Presv Free, 36+ Mos

1004

Mening. (MCV4O)

993 136

Influ split 18+ yrs pres free

924

Prev. Smallpox-Recall Date

220

Influenza Split 61 15

Hep B Ped/Adol - W/Thimerosal

101

HIV 2002 61

Meningococcal C Conjugate

919 103

Prev. Smallpox-Childhood

219

Hep A 2 dose - Ped/Adol 12+ mos.

923 923

Dengue Fever 2001 56

Herpes Simplex 2

2007 60

Diluent 222


4-16

CPT Code


CVX Code

Expiration Date

Rotavirus, tetravalent

59 74

Smallpox Equivocal Take

218

Td-IPV 975

Novel H1N1,Injectable, 18+ Yrs

1009

DTaP/IPV/Hib/HepB Historical

611 132

Prev. Smallpox-Not Vaccinated/Unknown

224

Leishmaniasis 2009 64

Hantavirus 2004 57

Q Fever 2015 70

Malaria 2011 67

Typhoid, NOS 604 91

Rotavirus, NOS 608 122

Polio - unspecified

204 89

VEE, live 2024 80

Junin Virus 2008 63

Hep A--unspecified

107 85

Appendices

4-17

CPT Code


CVX Code

Expiration Date

Novel H1N1,Presv Free, 18+ Yrs

1006


1007

Smallpox No Take

215

Melanoma 2012 68

No vaccine administered

2013 998

Smallpox Major Take

214

Novel H1N1,Presv Free, 6-35 Mos

1001

Hep E 2006 59

DTP - unspecified

206

VZIG (IND) 926 117

Tularemia Vaccine

2021 78

Leprosy 2010 65

Tetanus toxoids, NOS

217 112

Botulinum Toxoid

917

Hepatitis A- pediatric, NOS

109


4-18

CPT Code


CVX Code

Expiration Date

DTP/Hib/Hep B 106 102

Staphylococcus Bacteria Lysate

2018 76

VEE, Inactivated

2022 81

Lead Blood Draw

225

Meningococcal, NOS

922 108

Adenovirus, NOS

2000 82

Influenza, H51N-1203

976 123

Tetanus toxoids, adsorbed

216

Appendices

4-19

APPENDIX B: STATE COUNTY CODES

ARIZONA

COUNTY COUNTY CODE

ARIZONA

APACHE 4001 COCHISE 4003 COCONINO 4005 GILA 4007 GRAHAM 4009 GREENLEE 4011 LA PAZ 4012 MARICOPA 4013 MOHAVE 4015 NAVAJO 4017 PIMA 4019 PINAL 4021 SANTA CRUZ 4023 YAVAPAI 4025 YUMA 4027


4-20

IDAHO

COUNTY COUNTY CODE

IDAHO

ADA 16001 ADAMS 16003 BANNOCK 16005 BEAR LAKE 16007 BENEWAH 16009 BINGHAM 16011 BLAINE 16013 BOISE 16015 BONNER 16017 BONNEVILLE 16019 BOUNDARY 16021 BUTTE 16023 CAMAS 16025 CANYON 16027 CARIBOU 16029 CASSIA 16031 CLARK 16033 CLEARWATER 16035 CUSTER 16037 ELMORE 16039 FRANKLIN 16041 FREMONT 16043 GEM 16045 GOODING 16047 IDAHO 16049 JEFFERSON 16051 JEROME 16053 KOOTENAI 16055 LATAH 16057 LEMHI 16059 LEWIS 16061 LINCOLN 16063 MADISON 16065 MINIDOKA 16067 NEZ PERCE 16069 ONEIDA 16071 OWYHEE 16073 PAYETTE 16075 POWER 16077 SHOSHONE 16079

Appendices

4-21

COUNTY COUNTY CODE

IDAHO

TETON 16081 TWIN FALLS 16083 VALLEY 16085 WASHINGTON 16087


4-22

INDIANA

COUNTY COUNTY CODE

INDIANA

ADAMS 18001 ALLEN 18003 BARTHOLOMEW 18005 BENTON 18007 BLACKFORD 18009 BOONE 18011 BROWN 18013 CARROLL 18015 CASS 18017 CLARK 18019 CLAY 18021 CLINTON 18023 CRAWFORD 18025 DAVIESS 18027 DE KALB 18033 DEARBORN 18029 DECATUR 18031 DELAWARE 18035 DUBOIS 18037 ELKHART 18039 FAYETTE 18041 FLOYD 18043 FOUNTAIN 18045 FRANKLIN 18047 FULTON 18049 GIBSON 18051 GRANT 18053 GREENE 18055 HAMILTON 18057 HANCOCK 18059 HARRISON 18061 HENDRICKS 18063 HENRY 18065 HOWARD 18067 HUNTINGTON 18069 JACKSON 18071 JASPER 18073 JAY 18075

Appendices

4-23

COUNTY COUNTY CODE

INDIANA

JEFFERSON 18077 JENNINGS 18079 JOHNSON 18081 KNOX 18083 KOSCIUSKO 18085 LA PORTE 18091 LAGRANGE 18087 LAKE 18089 LAWRENCE 18093 MADISON 18095 MARION 18097 MARSHALL 18099 MARTIN 18101 MIAMI 18103 MONROE 18105 MONTGOMERY 18107 MORGAN 18109 NEWTON 18111 NOBLE 18113 OHIO 18115 ORANGE 18117 OWEN 18119 PARKE 18121 PERRY 18123 PIKE 18125 PORTER 18127 POSEY 18129 PULASKI 18131 PUTNAM 18133 RANDOLPH 18135 RIPLEY 18137 RUSH 18139 SCOTT 18143 SHELBY 18145 SPENCER 18147 ST. JOSEPH 18141 STARKE 18149 STEUBEN 18151 SULLIVAN 18153 SWITZERLAND 18155 TIPPECANOE 18157 TIPTON 18159 UNION 18161


4-24

COUNTY COUNTY CODE

INDIANA

VANDERBURGH 18163 VERMILLION 18165 VIGO 18167 WABASH 18169 WARREN 18171 WARRICK 18173 WASHINGTON 18175 WAYNE 18177 WELLS 18179 WHITE 18181 WHITLEY 18183

Appendices

LOUISIANA

COUNTY COUNTY CODE

LOUISIANA

ACADIA 22001 ALLEN 22003 ASCENSION 22005 ASSUMPTION 22007 AVOYELLES 22009 BEAUREGARD 22011 BIENVILLE 22013 BOSSIER 22015 CADDO 22017 CALCASIEU 22019 CALDWELL 22021 CAMERON 22023 CATAHOULA 22025 CLAIBORNE 22027 CONCORDIA 22029 DE SOTO 22031 EAST BATON ROUGE 22033 EAST CARROLL 22035 EAST FELICIANA 22037 EVANGELINE 22039 FRANKLIN 22041 GRANT 22043 IBERIA 22045 IBERVILLE 22047 JACKSON 22049 JEFFERSON 22051 JEFFERSON DAVIS 22053 LA SALLE 22059 LAFAYETTE 22055 LAFOURCHE 22057 LINCOLN 22061 LIVINGSTON 22063

4-25


COUNTY COUNTY CODE

LOUISIANA

MADISON 22065 MOREHOUSE 22067 NATCHITOCHES 22069 ORLEANS 22071 OUACHITA 22073 PLAQUEMINES 22075 POINTE COUPEE 22077 RAPIDES 22079 RED RIVER 22081 RICHLAND 22083 SABINE 22085 ST. BERNARD 22087 ST. CHARLES 22089 ST. HELENA 22091 ST. JAMES 22093 ST. JOHN THE BAPTIST 22095 ST. LANDRY 22097 ST. MARTIN 22099 ST. MARY 22101 ST. TAMMANY 22103 TANGIPAHOA 22105 TENSAS 22107 TERREBONNE 22109 UNION 22111 VERMILION 22113 VERNON 22115 WASHINGTON 22117 WEBSTER 22119 WEST BATON ROUGE 22121 WEST CARROLL 22123 WEST FELICIANA 22125 WINN 22127

4-26

Appendices

4-27

WASHINGTON

COUNTY COUNTY CODE

WASHINGTON

ADAMS 53001 ASOTIN 53003 BENTON 53005 CHELAN 53007 CLALLAM 53009 CLARK 53011 COLUMBIA 53013 COWLITZ 53015 DOUGLAS 53017 FERRY 53019 FRANKLIN 53021 GARFIELD 53023 GRANT 53025 GRAYS HARBOR 53027 ISLAND 53029 JEFFERSON 53031 KING 53033 KITSAP 53035 KITTITAS 53037 KLICKITAT 53039 LEWIS 53041 LINCOLN 53043 MASON 53045 OKANOGAN 53047 PACIFIC 53049 PEND OREILLE 53051 PIERCE 53053 SAN JUAN 53055 SKAGIT 53057 SKAMANIA 53059 SNOHOMISH 53061 SPOKANE 53063 STEVENS 53065 THURSTON 53067 WAHKIAKUM 53069 WALLA WALLA 53071 WHATCOM 53073 WHITMAN 53075 YAKIMA 53077


4-28

WEST VIRGINIA

COUNTY COUNTY CODE

WEST VIRGINIA

BARBOUR 54001 BERKELEY 54003 BOONE 54005 BRAXTON 54007 BROOKE 54009 CABELL 54011 CALHOUN 54013 CLAY 54015 DODDRIDGE 54017 FAYETTE 54019 GILMER 54021 GRANT 54023 GREENBRIER 54025 HAMPSHIRE 54027 HANCOCK 54029 HARDY 54031 HARRISON 54033 JACKSON 54035 JEFFERSON 54037 KANAWHA 54039 LEWIS 54041 LINCOLN 54043 LOGAN 54045 MARION 54049 MARSHALL 54051 MASON 54053 MCDOWELL 54047 MERCER 54055 MINERAL 54057 MINGO 54059 MONONGALIA 54061 MONROE 54063 MORGAN 54065 NICHOLAS 54067 OHIO 54069 PENDLETON 54071 PLEASANTS 54073 POCAHONTAS 54075 PRESTON 54077 PUTNAM 54079

Appendices

4-29

COUNTY COUNTY CODE

WEST VIRGINIA

RALEIGH 54081 RANDOLPH 54083 RITCHIE 54085 ROANE 54087 SUMMERS 54089 TAYLOR 54091 TUCKER 54093 TYLER 54095 UPSHUR 54097 WAYNE 54099 WEBSTER 54101 WETZEL 54103 WIRT 54105 WOOD 54107 WYOMING 54109


4-30

WYOMING

COUNTY COUNTY CODE

WYOMING

ALBANY 56001 BIG HORN 56003 CAMPBELL 56005 CARBON 56007 CONVERSE 56009 CROOK 56011 FREMONT 56013 GOSHEN 56015 HOT SPRINGS 56017 JOHNSON 56019 LARAMIE 56021 LINCOLN 56023 NATRONA 56025 NIOBRARA 56027 PARK 56029 PLATTE 56031 SHERIDAN 56033 SUBLETTE 56035 SWEETWATER 56037 TETON 56039 UINTA 56041 WASHAKIE 56043 WESTON 56045

Appendices

4-31

APPENDIX C: ETHNICITY CODES

ETHNICITY CODE

DESCRIPTION

1 Hispanic

2 Non-Hispanic

3 Unknown

APPENDIX D: RACE CODES

RACE CODE DESCRIPTION

1 Caucasian (or White)

2 African American

4 Asian

5 Native American (or American Indian)

6 Other

7 Native Hawaiian or Other Pacific Islander

8 Multi-Racial


4-32

APPENDIX E: INACTIVE CODES

INACTIVE CODE

DESCRIPTION

A Address Incorrect

D Deceased

F Postal Forward Order Expired

G Moved or Gone Elsewhere

M Moved out of State

N No Postal Forward on File

O Other

P Changed to another provider

R (Indiana Only) Archive

U Delivery Unsuccessful

APPENDIX F: VFC ELIGIBLE CODES

VFC CODE DESCRIPTION

(blank) Ineligible

1 Medicaid

2 Uninsured

3 Native American or Native Alaskan

4 Underinsured

6 (for Arizona use only) Kids Care

7 (for Indiana use only) Hoosier Healthwise Package C

Appendices

4-33

APPENDIX G: ANATOMICAL SITE & ROUTE CODES

ANATOMICAL SITE CODES

ANATOMICAL SITE CODE

DESCRIPTION

LEFT_ARM Left Arm

LEFT_THIGH Left Thigh

LEFT_GLUTEUS Left Gluteus

MOUTH Mouth

NOSE Nose

RIGHT_ARM Right Arm

RIGHT_THIGH Right Thigh

RIGHT_GLUTEUS Right Gluteus

ANATOMICAL ROUTE CODES

ANATOMICAL ROUTE CODE

DESCRIPTION

INTRAMUSCULAR Intramuscular

INTRADERMAL Intradermal

SUBCUTANEOUS Subcutaneous

ORAL Oral

NASAL Nasal


4-34

APPENDIX H: MANUFACTURER CODES

CODE MANUFACTURER

NAME NOTES

STATUS

AB Abbott Laboratories includes Ross Products Division, Solvay

Active

ACA Acambis, Inc Acquired by sanofi in sept 2008 Inactive

AD Adams Laboratories, Inc.

Active

AKR Akorn, Inc Active

ALP Alpha Therapeutic Corporation

Active

AR Armour Part of CSL Inactive

AVB Aventis Behring L.L.C. Part of CSL Inactive

AVI Aviron Acquired by Medimmune Inactive

BA Baxter Healthcare Corporation-inactive

Inactive

BAH Baxter Healthcare Corporation

Includes Hyland Immuno, Immuno International AG,and North American Vaccine, Inc./acquired some assets from alpha therapeutics

Active

BAY Bayer Corporation Bayer Biologicals now owned by Talecris

Inactive

BP Berna Products Inactive

BPC Berna Products Corporation

Includes Swiss Serum and Vaccine Institute Berne

Active

BTP Biotest Pharmaceuticals Corporation

New owner of NABI HB as of December 2007, Does NOT replace NABI Biopharmaceuticals in this code list.

Active

Appendices

4-35

CODE MANUFACTURER

NAME NOTES

STATUS

CEN Centeon L.L.C. Inactive

CHI Chiron Corporation Part of Novartis Inactive

CMP Celltech Medeva Pharmaceuticals

Part of Novartis Inactive

CNJ Cangene Corporation Active

CON Connaught Acquired by Merieux Inactive

CSL CSL Behring, Inc CSL Biotherapies renamed to CSL Behring

Active

DVC DynPort Vaccine Company, LLC

Active

EVN Evans Medical Limited Part of Novartis Inactive

GEO GeoVax Labs, Inc. Active

GRE Greer Laboratories, Inc.

Active

IAG Immuno International AG

Part of Baxter Inactive

IM Merieux Part of Sanofi Inactive

INT Intercell Biomedical Active

IUS Immuno-U.S., Inc. Active

JPN The Research Foundation for Microbial Diseases of Osaka University (BIKEN)

Active

KGC Korea Green Cross Corporation

Active


4-36

CODE MANUFACTURER

NAME NOTES

STATUS

LED Lederle Became a part of WAL, now owned by Pfizer

Inactive

MA Massachusetts Public Health Biologic Laboratories

Inactive

MBL Massachusetts Biologic Laboratories

Formerly Massachusetts Public Health Biologic Laboratories

Active

MED MedImmune, Inc. Acquisitions of U.S. Bioscience in 1999 and Aviron in 2002, as well as the integration with Cambridge Antibody Technology and the strategic alignment with our new parent company, AstraZeneca, in 2007.

Active

MIL Miles Inactive

MIP Emergent BioDefense Operations Lansing

Bioport renamed. Formerly Michigan Biologic Products Institute

Active

MSD Merck & Co., Inc. Active

NAB NABI Formerly North American Biologicals, Inc.

Active

NAV North American Vaccine, Inc.

Part of Baxter Inactive

NOV Novartis Pharmaceutical Corporation

Includes Chiron, PowderJect Pharmaceuticals, Celltech Medeva Vaccines and Evans Limited, Ciba-Geigy Limited and Sandoz Limited

Active

NVX Novavax, Inc. Active

NYB New York Blood Center

Active

ORT Ortho-clinical Diagnostics

A J&J company (formerly Ortho Diagnostic Systems, Inc.)

Active

Appendices

4-37

CODE MANUFACTURER

NAME NOTES

STATUS

OTC Organon Teknika Coporation

Active

OTH Other manufacturer Active

PD Parkedale Pharmaceuticals

No website and no news articles (formerly Parke-Davis)

Inactive

PFR Pfizer, Inc Includes Wyeth-Lederle Vaccines and Pediatrics, Wyeth Laboratories, Lederle Laboratories, and Praxis Biologics,

Active

PMC sanofi pasteur Formerly Aventis Pasteur, Pasteur Merieux Connaught; includes Connaught Laboratories and Pasteur Merieux. Acquired ACAMBIS.

Active

PRX Praxis Biologics Became a part of WAL, now owned by Pfizer

Inactive

PWJ PowderJect Pharmaceuticals

See Novartis Inactive

SCL Sclavo, Inc. Active

SI Swiss Serum and Vaccine Inst.

Part of Berna Inactive

SKB GlaxoSmithKline Includes SmithKline Beecham and Glaxo Wellcome

Active

SOL Solvay Pharmaceuticals

Part of Abbott Inactive

TAL Talecris Biotherapeutics

Includes Bayer Biologicals Active

UNK Unknown manufacturer

Active

USA United States Army Medical Research and Material Command

Active


4-38

CODE MANUFACTURER

NAME NOTES

STATUS

VXG VaxGen Acquired by Emergent Biodefense Operations Lansing, Inc

Inactive

WA Wyeth-Ayerst Became WAL, now owned by Pfizer Inactive

WAL Wyeth Acquired by Pfizer 10/15/2009 Inactive

ZLB ZLB Behring Acquired by CSL Inactive

APPENDIX I: ADVERSE REACTION CODES

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

Anthrax 22 Injection site reaction

Anthrax 23 Systemic reactions, i.e., immediate hypersensitivity, fever of muscle aches.

DT Pediatric 2 Anaphylaxis or anaphylactic shock

DT Pediatric 3 Brachial neuritis

DT Pediatric 4 Any sequel (including death) of events

DTP 2 Anaphylaxis or anaphylactic shock

DTP 3 Brachial neuritis

DTP 4 Any sequela (including death) of events

DTP 5 Encephalopathy (or encephalitis)

DTP/Hib 2 Anaphylaxis or anaphylactic shock

Appendices

4-39

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

DTP/Hib 3 Brachial Neuritis

DTP/Hib 4 Any sequela (including death) of events

DTP/Hib 5 Encephalopathy (or encephalitis)

DTP/IPV 2 Anaphylaxis or anaphylactic shock

DTP/IPV 3 Brachial neuritis

DTP/IPV 4 Any sequela (including death) of events

DTP/IPV 5 Encephalopathy (or encephalitis)

DtaP 2 Anaphylaxis or anaphylactic shock

DtaP 3 Brachial neuritis

DtaP 4 Any sequela (including death) of events

DtaP 5 Encephalopathy (or encephalitis)


2 Anaphylaxis or anaphylactic shock


3 Brachial neuritis


4 Any sequela (including death) of events


5 Encephalopathy (or encephalitis)

DTaP/Hep B/IPV 2 Anaphylaxis or anaphylactic shock

DTaP/Hep B/IPV 3 Brachial neuritis

DTaP/Hep B/IPV 4 Any sequela (including death) of events


4-40

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

DTaP/Hep B/IPV 5 Encephalopathy (or encephalitis)

DTaP/Hib 2 Anaphylaxis or anaphylactic shock

DTaP/Hib 3 Brachial neuritis

DTaP/Hib 4 Any sequela (including death) of events

DTaP/Hib 5 Encephalopathy (or encephalitis)

Hep B – unspecified


Hep B – unspecified


Hep B 2 dose – Adol/Adult


Hep B 2 dose – Adol/Adult


Hep B Ped/Adol – Preserv Free


Hep B Ped/Adol – Preserv Free


Hep B Ped/Adol – W/Thimerosal


Hep B Ped/Adol – W/Thimerosal


Hep B/Hib 2 Anaphylaxis or anaphylactic shock

Hep B/Hib 4 Any sequela (including death) of events

Hepatitis B—adult


Hepatitis B—adult


Hib—PRP-OMP 4 Any sequela (including death) of events

Hib—PRP-OMP 15 Early on-set HIB disease

Appendices

4-41

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

Hib—PRP-T 4 Any sequela (including death) of events

Hib—PRP-T 15 Early on-set HIB disease

Hib-PRP-D 4 Any sequela (including death) of events

Hib-PRP-D 15 Early on-set HIB disease

IPV 2 Anaphylaxis or anaphylactic shock

IPV 4 Any sequela (including death) of events

M/R 2 Anaphylaxis or anaphylactic shock

M/R 4 Any sequela (including death) of events

M/R 5 Encephalopathy (or encephalitis)

M/R 6 Chronic arthritis

M/R 7 Thrombocytopenic purpura

M/R 8 Vaccine-strain measles viral infection in an immunodeficient recipient

MMR 2 Anaphylaxis or anaphylactic shock

MMR 4 Any sequela (including death) of events

MMR 5 Encephalopathy (or encephalitis)

MMR 6 Chronic arthritis

MMR 7 Thrombocytopenic purpura

MMR 8 Vaccine-strain measles viral infection in an immunodeficient recipient

MMR/Varicella 2 Anaphylaxis or anaphylactic shock

MMR/Varicella 4 Any sequela (including death) of events


4-42

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

MMR/Varicella 5 Encephalopathy (or encephalitis)

MMR/Varicella 6 Chronic arthritis

MMR/Varicella 7 Thrombocytopenic purpura

MMR/Varicella 8 Vaccine-strain measles viral infection in an immunodeficient recipient

Measles 2 Anaphylaxis or anaphylactic shock

Measles 4 Any sequela (including death) of events

Measles 5 Encephalopathy (or encephalitis)

Measles 7 Thrombocytopenic purpura

Measles 8 Vaccine-strain measles viral infection in an immunodeficient recipient

Mumps 2 Anaphylaxis or anaphylactic shock

Mumps 4 Any sequela (including death) of events

Mumps 5 Encephalopathy (or encephalitis)

OPV 4 Any sequela (including death) of events

OPV 9 Paralytic polio in a non-immunodeficient recipient

OPV 10 Paralytic polio in an immunodeficient recipient

OPV 11 Paralytic polio in a vaccine-associated community case

OPV 12 Vaccine-strain polio viral infection in a non-immunodeficient recipient

OPV 13 Vaccine-strain polio viral infection in an immunodeficient recipient

Appendices

4-43

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

OPV 14 Vaccine-strain polio viral infection in a vaccine-associated community case

Pertussis 2 Anaphylaxis or anaphylactic shock

Pertussis 4 Any sequela (including death) of events

Pertussis 5 Encephalopathy (or encephalitis)

Rubella 2 Anaphylaxis or anaphylactic shock

Rubella 4 Any sequela (including death) of events

Rubella 5 Encephalopathy (or encephalitis)

Rubella 6 Chronic arthritis

Rubella/Mumps 2 Anaphylaxis or anaphylactic shock

Rubella/Mumps 4 Any sequela (including death) of events

Rubella/Mumps 5 Encephalopathy (or encephalitis)

Rubella/Mumps 6 Chronic arthritis

Smallpox 16 Inadvertent autoinoculaton

Smallpox 17 Eczema vaccinatum

Smallpox 18 Generalized vaccinia

Smallpox 19 Progressive vaccinia

Smallpox 20 Erythematous or urticarial rashes

Smallpox 21 Post vaccinial encephalitis

Smallpox 24 Fetal vaccinia

Smallpox 25 Death

Td (Adult) 2 Anaphylaxis or anaphylactic shock

Td (Adult) 3 Brachial neuritis


4-44

VACCINE NAME

ADVERSE REACTION

CODE

DESCRIPTION

Td (Adult) 4 Any sequela (including death) of events

Tetanus Toxoid 2 Anaphylaxis or anaphylactic shock

Tetanus Toxoid 3 Brachial neuritis

Tetanus Toxoid 4 Any sequela (including death) of events

Tetanus Toxoids, NOS



3 Brachial neuritis



APPENDIX J: ICD-9 CODES

The mappings of ICD-9 Codes to SIIS Vaccine Codes are listed in the table.

ICD9

CODE

SIIS VACC CODE

ICD9

DESCRIPTION

V06.1 206 Immunization, DTP

V06.3 55 Immunization, DTP/polio

V05.3 45 Immunization, Hepatitis

V03.81 17 Immunization, HIB

V04.81 108 Immunization, Influenza

V06.4 3 Immunization, MMR

Appendices

4-45

ICD9

CODE

SIIS VACC CODE

ICD9

DESCRIPTION

V03.82 205 Immunization, Pneumovax

V04.0 204 Immunization, Polio

V04.82 208 Immunization, RSV

V04.1 207 Immunization, Smallpox

V06.5 9 Immunization, Td

V03.1 604 Immunization, Typhoid

V05.4 21 Immunization, Varicella

Appendices

4-47


Mapped Value

Field Position

Data Type Comments

patient.

Patient First Name 48 R String

Patient Last Name 48 R String

Patient DOB 10 R Date Format: Dates can be defined in the profile, so they can be sent in any standard format, i.e., MM/DD/YYYY

Note: If additional information such as a timestamp is sent with the date, the DTT will strip it off and only store the date in the registry.

*At least one of these three FAMILY fields is required. (Note: Use all of these fields if they are available.)

Guardian First Name 48 R* String

Mother Maiden Name 48 R* String

Guardian Social Security Number

11 R* String

**At least one of these three ADDRESS field combinations MUST be used. a) Patient 1st Address / Street Line 1 with Patient 1st Address / City and Patient 1st Address / State b) Patient 1st Address / Street Line 1 with Patient 1st Address / Zip Code and Patient 1st Address / State c) Patient Phone Number with Patient Phone Area Code and Patient 1st Address / State

Patient 1st Address / Street Line 1

45 R** String If the patient's mailing address is a P.O. Box, spell out P.O. Box, PO Box, POB, P.O.B. or Box followed by a space and the number, and if possible, put the physical address in the Patient Physical Address field.


4-48


Mapped Value

Field Position

Data Type Comments

If the patient has a street address, put the entire street address here including suite number, etc. and leave the Patient Physical Address field blank.

Note: Use all of these fields if they are available.

Note: If Patient 1st Address Street Line1 is the same as Patient 1st Address Street Line 2, Street Line 2 is discarded when deduplication is run. If both addresses are sent, then “address type” is mandatory; otherwise, the address type defaults to “home.” When both Address 1 and Address 2 are “home,” Address 2 is seen as an update.

Patient 1st Address / City

30 R** String

Patient 1st Address / Is Valid

1 R Varchar Indicates that this is a valid mailing address for the patient.

Patient 1st Address / State

2 R** String

Patient 1st Address / Zip Code

10 R** Number

Patient 1st Address / Type

30 R** Varchar Type of address such as “primary” or “secondary.”

Appendices

4-49


Mapped Value

Field Position

Data Type Comments

Note: If you do not send an address type, the address type is assumed to be HOME. If two addresses are sent in with the same address type (by the same irmsSysId/irmsPatId), the second address is an update; but a non-primary address will never overwrite the primary address. So, in this scenario, the second address goes to address history but not to the regular patient record.

Note: If two addresses are sent, the DTT logic will insert two rows into the Patient Pre-Reserve staging table using the “Insert Patient” procedure. The rows will have identical information except the addresses will be different. The “Insert Patient” logic will create two address rows which will display in the multiple address section when viewing the patient.

Additionally, the DTT logic will check to see if the Primary flag is set to Y and if it is set to N or null, then it will default to Y.

If both addresses are sent, then “address type” is mandatory; otherwise, the address type defaults to “home.” When both Address 1 and Address 2 are “home,” Address 2 is seen as an update.


4-50


Mapped Value

Field Position

Data Type Comments

Note: Address Type is not available for DTT Exports.

Patient Phone Number Area Code

3 R** Number

Patient Phone Number 8 R** Number

If a FACILITY or PHYSICIAN is provided, it is recommended a Facility or Physician file is created for all known Physicians and/or Facilities. It is also recommended the Patient Record only contain the referenced Physician and/or Facility ID^

Facility ID 25 O^ String Your unique identifying number for a specific facility. Once you associate a unique identifier with a particular facility, you should always send the same number for that facility. On a patient record, this is the facility that identifies the patient’s medical home.

Physician ID 25 O^ String Your unique identifying number for a specific physician or vaccinator. Once you associate a unique identifier with a particular physician or vaccinator, you should always send the same number for that physician or vaccinator. On a patient record, this is the physician that identifies the patient’s primary care physician.

Birth Order 2 O Number Specifies the birth order when there are multiple births; i.e., 1 of 3, 2 of 3, etc.

Note: This field must be sent with Multiple Birth Count; thus, birth order of Multiple Birth Count. Both fields must be sent together, not

Appendices

4-51


Mapped Value

Field Position

Data Type Comments

singularly.

Birthing Facility 100 O Varchar

Block Recall 1 O String Specifies whether the patient should be blocked from being recalled via Reminder Recall. Y indicates the patient should be blocked from being recalled; otherwise, leave blank.

Comments 254 O String

Death Date 10 O Date

Email Bounce Reason 30 O Varchar Used when importing invalid e-mail address reasons via the Constant Contact file (reasons typically include: Blocked, Mailbox Full, Non-Existent Address, Other, Undeliverable, and Unsubscribe).

It is typically used with the Serial Number field which is the unique email identifier from the OneCode ACS Service (Health Promotions).

When a bad address is received, all instances of that e-mail in the database are invalidated for primaries along with the Family/Friends and Provider/Other tables.

Guardian Full Name 153 O String

Guardian Last Name 48 O String

Guardian Middle Name 48 O String


4-52


Mapped Value

Field Position

Data Type Comments

Guardian Work Phone Number

10 O Number Format: (999) 999-9999

Inactive Code 1 O Number Code that determines if the child is still an “active” patient in the plan or practice. Leaving this field blank indicates the patient is active.

Acceptable codes are located in Appendix E.

Legacy Patient ID 30 O String

Managed Care Plan Date

10 O Date Date patient enrolled in managed health care plan.

Note: Dates can be defined in the profile, so they can be sent in any standard format.

If additional information such as a timestamp is sent with the date, the DTT will strip if off and only store the date in the registry.

Managed Care Plan ID 25 O String Identifying number associated with the patient’s health care plan.

Managed Care Plan Name

30 O String

Military 1 O String

Multiple Birth Count 2 O Number Specifies the total birth count when there are multiple births; i.e., 1 of 3, 2 of 3, etc.

Note: This field must be sent with Birth

Appendices

4-53


Mapped Value

Field Position

Data Type Comments

Order; thus, birth order of Multiple Birth Count. Both fields must be sent together, not singularly.

Patient Address County Code

38 O String


45 O String If the patient's mailing address is a P.O. Box, spell out P.O. Box, PO Box, POB, P.O.B. or Box followed by a space and the number, and if possible, put the physical address in the Patient Physical Address field.

If the patient has a street address, put the entire street address here including suite number, etc. and leave the Patient Physical Address field blank.

Note: Use all of these fields if they are available.

Note: If Patient 1st Address Street Line1 is the same as Patient 1st Address Street Line 2, Street Line 2 is discarded when deduplication is run.

Patient 2nd Address / Street Line 1

45 O String If two addresses are sent, the first address is considered the primary address and that is the address that appears on the Patient Master/Reserve Records.


4-54


Mapped Value

Field Position

Data Type Comments

Patient 2nd Address / Street Line 2

45 O String If two addresses are sent, the first address is considered the primary address and that is the address that appears on the Patient Master/Reserve Records.


Patient 2nd Address / City

30 O String

Patient 2nd Address / State

2 O String

Patient 2nd Address / Zip Code

10 O Number

Patient 2nd Address / Is Valid

1 O Varchar Indicates that this is a valid 2nd mailing address for the patient.

Patient 2nd Address / Type

30 O Varchar Indicates the type of address is “secondary.”

Note: If you do not send an address type, the address type is assumed to be HOME. If two addresses are sent in with the same address type (by the same irmsSysId/irmsPatId), the second address is an update; but a non-primary address will never overwrite the primary address. So, in this scenario, the

Appendices

4-55


Mapped Value

Field Position

Data Type Comments

second address goes to address history but not to the regular patient record.


Note: Address Type is not available for DTT Exports.

Patient Admission Date

10 O Date

Patient Birth Country 2 O String

Patient Birth File Number 16 O

String

Patient Birth State 2 O String

Patient Block Health Promotion 30 O

String

Patient Cell Phone 38 O Number

Patient County FIPS Code

10 O Number Acceptable codes are located in Appendix B.

Note: Code-based fields (fields contained the word “code”) can be mapped (which means translating the import file code to coincide with the SIIS registry acceptance codes).


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Mapped Value

Field Position

Data Type Comments

Patient Email Address 40 O String Patient or guardian email address

Patient Ethnicity Code 12 O String Ethnicity codes are located in Appendix C.


Patient Full Name 153 O String

Patient Gender Code 1 O String M for Male, F for Female, U for Unknown, O for Other.


Patient Grade 32 O Varchar This field can be mapped or you can use the code that already exists in the system.

Patient Health District/Region

12 O String Must be Numeric.

Patient Language Code 1 O String E=English, S=Spanish.


Appendices

4-57


Mapped Value

Field Position

Data Type Comments


40 O String

Patient Medicaid Number

16 O String

Patient Medicaid Provider Number

30 O String This is an alphanumeric field.

Patient Middle Name 48 O String

Patient Occupation Code

10 O String

Patient Phone Extension

10 O Number

Patient Physical Address

45 O String Used when a PO Box is used. Indicates where the patient actually lives.

Patient Race Code 1 O String Acceptable codes are located in Appendix D. Note: Code-based fields (fields contained the word “code”) can be mapped (which means translating the import file code to coincide with the SIIS registry acceptance codes).

Patient Record Created By

30 O String

Patient Record Creation Date

10 O Date


4-58


Mapped Value

Field Position

Data Type Comments

Patient Record Last Update

10 O String

Patient Record Last Updated By

30 O String

Patient SSN 11 O Number Format: 999-99-9999

Patient Suffix 5 O String Sr., Jr., etc.

Patient VFC Eligible Code

2 O Number Acceptable codes are located in Appendix F.


Patient Work Phone 38 O Number

Programs List 60 O String A semi-colon delimited list of programs the patient belongs. The program name must exactly match the name used by the receiving system. To specify a member ID for a program, place a comma after the program name, followed by the member ID for that program.

School District Code 12 O Number Positive integer. This is the School Identifier that is assigned by IWeb and is not truly a district. The School IDs table is available upon request.

School Entry Date 10 O Date

Appendices

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Mapped Value

Field Position

Data Type Comments

School External District ID

20 O Varchar (State-specific for LA). Used for a one-time import of Louisiana school data to link schools to JPAMS school codes. School codes will be stored in the Other System ID field. School code will allow immunization data sent by schools using JPAMS system to be linked to School Reports in the School Nurse Module. It should be noted that each year, LA will obtain an updated list from the Department of Education containing all active schools in the state. This import will need to occur each year before the start of the school year.

School External School ID

20 O Varchar Refer to the comments for the field, “School External District ID.”

School ID 38 O Number

Serial Number 9 O Number This is a 9-digit number and is part of the OneCode ACS service (Health Promotions). It is used when importing invalid e-mail address reasons via the Constant Contact file with the Email Bounce Reason field (reasons typically include: Blocked, Mailbox Full, Non-Existent Address, Other, Undeliverable, and Unsubscribe).

When a bad address is received, invalidate all instances of that e-mail in the database for primaries along with the Family/Friends and Provider/Other tables.

Appendices

4-61


Mapped Value

Field Position

Data Type

Comments

Immunization Date 10 R Date

Date a shot was given.

Format: Dates can be defined in the profile, so they can be sent in any standard format, i.e., MM/DD/YYYY

Note: If additional information such as a timestamp is sent with the date, the DTT will strip it off and only store the date in the registry.

At least one of the three vaccine code types*

CPT Vaccine Code 38 R* Number

CDC Vaccine Code 38 R* Number

SIIS Vaccine Code 38 R* Number

You may map your values using the CDC Vaccine Code, SIIS vaccine Code, or CPT Vaccine Code. If the CPT Vaccine Code is not available, refer to Appendix A for a list of SIIS or CDC Vaccine codes that can be used in its place.

Note: "Code-based" fields (fields containing the word "code") can be mapped (which means translating the import file code to coincide with the SIIS registry acceptance codes).

If a Facility or Physician is provided, it is recommended a Facility or Physician file is created for all known Physicians and/or Facilities. It is also recommended the Patient Record only contain the referenced Physician and/or Facility ID^

Contraindication Facility ID

25 O^ String Facility ID where the contraindication was documented.

Facility ID 25 O^ String


4-62


Mapped Value

Field Position

Data Type

Comments

Vaccination Facility ID

25 O^ String This facility indicates the facility where the patient was vaccinated.

Vaccination Physician ID

25 O^ String This physician indicates the vaccinator.

Adv

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